3478 Indian Journal of Forensic Medicine & Toxicology, April-June 2021, Vol. 15, No. 2 Health Tourism Through Panchakarma with Special Reference of Sharadiya Virechana

Shubham Golokkumar Biswas1, Gandhali Upadhya2, Devyani Dasar3, Alok kumar Diwedi4 1PG Scholar, Department of Shalyatantra, Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod (H), Datta Meghe Institute of Medical Sciences, Wardha, 2Assistant Professor, Dept of Swasthvrutta, Gomantak Ayurveda Mahavidyalaya & Research Center, Shiroda, Goa, 3Associate Professor, Shalyatantra, Mahatma Gandhi Ayurved College Hospital and Research Centre. Salod (H), Wardha, Datta Meghe Institute of Medical Sciences, Wardha, 4PG Scholar, Department of Shalyatantra, Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod (H), Datta Meghe Institute of Medical Sciences, Wardha

Abstract Globalization is the process of international integration arising from interchange of the world’s views, products, ideas and other aspects of the culture. Ayurveda has holistic approach towards health and diseases, lifestyle, using medications, diet and their fewer side effect .Globalization helps to propagate Ayurveda worldwide with the help of health tourism.

India is emerging as a great destination for health tourism because it has several factors like excellent medical treatment at low cost, easy accessibility, picturesque locations for excellent holidays etc. Health tourism is not only beneficial for the foreigners but our country can also be benefitted financially. It will also help to spread the importance of Ayurveda worldwide. The physician can extend a helping hand in globalization of Ayurveda by being in their own motherland. Patients from industrialized nations seek health tourism because of high quality treatment at low cost.

Panchakarma is one of the specialty of Kayachikitsa presents unique approach of Ayurveda with shodhana procedures of the body. Panchakarma provides promotive, preventive, curative and rehabilative aspect. There has been phenomenal increase in the demand for Panchakarma. ritu is the time for Pitta prakopa. The pitta which was accumulated in Varsha ritu gets provoked by ushna guna during this . If proper care is not taken during this time, it will cause Pittaja vikara. Virechana is the method of purification, conducted in Sharad ritu for preventing and controlling pitta prakopa as a part of Ritukalina shodhana.

In this current paper, we would like to discuss different aspects of health tourism with special reference to Sharadiya Virechana, which will contribute to propagate Ayurveda globally.

Keywords: Globalization, Health tourism, Panchakarma, Sharad ritu, Virechana, Ritukalina shodhana, Pitta prakopa.

Introduction Corresponding Author: The mutual exchange of technology and knowledge Shubham Golokkumar Biswas, around the world is known as Globalization. It is a Department of Shalyatantra, Mahatma Gandhi Ayurved process of international integration arising from the College Hospital and Research Centre, Salod (H), Datta interchange of world’s views, products, ideas and other Meghe Institute of Medical Sciences, Wardha 442001, aspects. Internationalization holds great potential for E_mail: [email protected] Ayurveda in order to collaboration with other traditional Indian Journal of Forensic Medicine & Toxicology, April-June 2021, Vol. 15, No. 2 3479 and modern medical systems around the world to find during Sharad Ritu. This therapy will help to eliminate cures for global health care challenges, and to be part of the possibility of formation of the Pitta – Raktaj diseases. modern lifestyle. It is safe to carry out for the delicate stature foreigners. In this way by being in our own country an Ayurveda India, having one of the richest and most diverse physician can contribute towards globalisation of heritages in the world is not an exception to this global Ayurveda through Health tourism. trend. Ayurveda is the world’s most ancient methodical medical knowledge system. Ayurveda due to its holistic Aim: Globalisation of Ayurveda through Health approach using lifestyle medication, healthy diet, less tourism side effects, has attracted a large population in different Objective: To Review Health Tourism through countries around the world. There is a growing demand Panchakarma with special reference of Sharadiya for natural products in the international market. Global Virechana awareness on this traditional system has increased manifold over the past few decades, leading to the Materials and Methods: Thorough review acceptance of such medicine systems. of literature related to topics was done through the Ayurved Compendia, various other Ayurved texts and Health tourism or medical tourism is a niche textbooks of contemporary science. The references from tourism developed by the competing tourism promoting internet and journals were also critically reviewed. The countries in order to attract people travelling with the study had initiated for Affirmation of globalisation of prime purpose of getting healthcare. Health tourism is Ayurveda through Health tourism with special reference not only beneficial for the foreigners, but our country of Sharadiya Virechana. can also be benefitted financially. It will also help to spread the importance of Ayurveda worldwide. The Review of Literature physician can extend a helping hand in globalization of Ayurveda by being in their own motherland. Patients Health Tourism from industrialized nations seek health tourism because With the advent of globalization and culture of of high quality treatment at low cost. consumerism, people begin to travel to make use of Panchakarma therapy is considered as a complete wide variety of alternatives that bring satisfaction and holistic approach to the elimination of the root cause of healthy living. Now a day’s people are more conscious each and every chronic disease. The Doshas which are in maintaining a healthy body, mind and soul. Health removed by Langhana and Pachana Dravya they can tourism comprises of two terms healthcare and tourism. get aggravated sometimes, but the doshas which are Health tourism is becoming a preferred form of removed by Sanshodhana procedures they cannot get vacationing as its covers a broad spectrum of medical vitiated again. services and mixes leisure, fun and relaxation together with wellness and healthcare. Amongst the 5 shodhana therapies, Virechana is the best therapy for Pitta elimination. When the Tikshna and Health tourism is also known as medical tourism, Sheeta qualities of Pitta suddenly react with the Ushna wellness tourism, healthcare travel or medical value quality of Sharad Rutu, aggravation of Pitta Dosha is travel. Medical tourism is highly promoted by big seen. As a means of Ritukalina Shodhana, Virechana corporate hospitals in developing countries by providing is specially recommended in Sharad Rutu. It should high quality medical services at cheaper prices to be done in healthy individuals for maintaining health patients from industrialized nations. Health tourism and also in patients suffering from diseases in which is projected as a new segment in travel and healthcare Virechana Karma is indicated. business. Globally, medical tourism is said to be US $ 40 billion industry. Virechana therapy can be proved beneficial for the foreign nationals who reside in a country which predominantly shows environmental changes seen 3480 Indian Journal of Forensic Medicine & Toxicology, April-June 2021, Vol. 15, No. 2

Benefits of Health Tourism · The physician can work more efficiently in his mother land with easy availability of space, equipments, For the tourists: authentic drugs and trained staff, which is not possible if · People from industrialized nations seek health the doctors sets up the clinic out of India tourism because of high costs of treatment in their home Panchakarma: country. These are the Pradhana-karma (main procedure) · Health tourism destinations provide high quality of Panchakarma as described in Bhrihattrayee. treatment at low cost Besides Pradhana-karma there are Purva-karma (pre · People get an opportunity to visit a new country procedure) and Pashchata karma (post procedure). and enjoy its tourism products during the recuperative These three steps comprise Panchakarma. Purva-karma period. covers Snehana (oleation) and Swedana(fomentation). Paschata-karma includes the procedures indicated after · Wealthy patients from third world countries Pradhana karma that mainly comprise of Samsarjana also choose for health tourism as they get better service Karma (diet regimen after Panchakarma) and care from the health tourism provider. The shodhana procedures are, Vamana, Virechana, · Some health tourism destinations provide Basti, Shirovirechana and Raktamokshana alternative medicines and traditional form of treatments. Patients wish to take alternative medicines like Speciality of Panchakarma Ayurveda, Yoga through health tourism. The Doshas which are removed by Langhana and For the country: Pachana Dravya they can be aggravates sometimes, but the doshas which are removed by Sanshodhana · High quality treatment at a fraction of the cost, procedures they cannot occur again. Hence for eg : Likes in comparison to western countries, makes India an ideal roots of trees which are to be completely destroyed healthcare destination for highly specialized medical neither they occur again, in same way doshas should care. removed completely from its roots neither they will occur again. Hence Panchakarma treatment is best · India is a reliable destination to get high quality among other types of chikitsa[1]. of ancient treatment like authentic Ayurveda, Yoga etc, which are highly on demand. PITTA DOSHA & VIRECHANA

· The use of non-toxic, harmless herbs resources, Virechana is regarded as the most important amongst the waiting time for treatment in India is much lower all the therapies for Pitta by Ayurveda. It extracts the compared to other countries. entire pathogenic root of Pitta Dosha and when it is overcome, the Paittika manifestations in the body get · Country can be benefitted by increase in the pacified like the fire chamber which becomes cold when number of foreign visitors the fire is removed. · This will also help to raise the finances, which Virechana therapy is recommended in Ayurveda for will lead towards country’s development. treatment of Pitta. It not only eliminates Pitta but also For Ayurveda: acts on Kapha & Vata Dosha. Mild purgation in fact is recommended in Vata Chikitsa Upkrama in Ashtang · Classical form of Ayurveda can be practiced by hruday sutrasthan. Thus Virechana acts on Tridosha. the physicians But as it is most significant purification treatment for · Through the tourists from various countries the Pitta Dosha it is recommended in Sharad Rutu due to knowledge of Ayurveda can be propagated globally aggravation of Pitta during this period. It should be done in healthy individuals for maintaining health and also Indian Journal of Forensic Medicine & Toxicology, April-June 2021, Vol. 15, No. 2 3481 in patients suffering from diseases in which Virechana ROLE OF VIRECHANA IN SHARAD RUTU Karma is indicated. FOR PREVENTION OF PITTA

This evacuative therapy eliminates aggravated Though Swasthavritta is not among Ashtanga Dosha, excreta, alleviates diseases, improves strength of Ayurveda, it has its own importance in day to day and complexion and if administered properly, endows life. Ayurveda guides society with the concept of the person with a long life. Virechana sharpens daily-seasonal-social regimens as an integral part of memory, increases aquity of organs, energy, and maintenance of life. Critical equilibrium and homeostasis stability of all Dhatu, Agni and delays ageing. in Tridosha is responsible for health and ill-health. Chaya (increase in its own site), Prakopa (increase causing the spread from own site), Prashama (pacification) are Pitta prakopa Sharad Ritu Pathogenesis of in the three natural stages those occur according to daily Accumulation of Pitta in Varsha Rutu occurs due to periodical and seasonal variations. Amla Vipaka of food & medicines that occur naturally in Sharad Ritu is observed to exist usually from mid this season. Pitta does not reach the level of aggravation September to mid November in India. In this Ritu, Vata because of external cold due to rain. Pitta accumulation undergoes stage of Shamana where as Pitta attains stage occurs when internal qualities like Tikshna acts together of Prakopa. Acharyas suggested various purificatory with external qualities like Sheeta. When these Tikshna procedures, changes in diet and behavioural regimens and Sheeta qualities suddenly act with the Ushna in order to conquer the natural variation of Dosha in quality in Sharad Rutu, aggravation of Pitta Dosha is particular season. Virechana stands the best line of seen. Due to this aggravation there are higher chances management for Pitta-Raktha and Vathaja conditions. It of getting diseases related to Pitta Dosha Prakopa. is a major therapy along with usage of Tiktha Dravyas Such as burning sensation,temperature, perspiration, indicated as a part of seasonal purificatory therapy in suppuration, sloughing, fainting, gangrenes, moisture, Sharad ritu intoxication, prostrations, sore or acrid eructation etc. VIRECHANA Sadharana kala for Ritukalina Shodhana[2]: Nirukti: The word ‘Virehchana’ is derived from = KAPHA shodhana ‘Richa’ Dhatu (i.e. detachment of relation). The word Falguna “Recana” is commonly used as evacuation. Thus, Virechana means Maladeh Nirharanam i.e. removal of Vaishakha Mala from the body. It means that which eliminates the impurity from the lower part of the gut[3]. Jyestha CLASSIFICATION OF VIRECHANA Aashad Margashirsha DRAVYA Shravana = VATA shodhana Bhadrapad Ashwin Sukhma virechana, Mridu virechana, Teekshna = PITTA shodhana virechana Sharad Ritu: Acc. to Sharangadhara – Sharad Ritu is considered to be breeding period for Anulomana – hareetaki, Sramsana – kritamalaka, the disease. Bhedana – katuka, Rechana - trivritta Sharad ritu (): VisargaKaal Speciality of Virechana over vamana: Bharatiya month: Ashwin and Kartik · Virechana is regarded as the best one among all English month: October and November the therapeutic measures for Pitta elimination. 3482 Indian Journal of Forensic Medicine & Toxicology, April-June 2021, Vol. 15, No. 2

· Virechana Karma is easily accepted by the Benefits: patients and foreigners because it includes snehapana The benefits of virechana are : It improves and purgation which can be done at home intelligence, gives strength to sense organs, stableness · Vamana is generally avoided by patients due to in dhatu, increases utsaha ( feels powerful and energetic fear of complications and they are difficult to manage ), increase hunger, also delayed ageing when the person than virechana. Hence virechana is safer. takes virechana( accordingly to seasonal vairiations),it also destroyed PittajanyaVyadhi[6]. · Virechana Karma is the act of expelling Doshas through Adhobhaga i.e. Guda. The Doshas even from For example, When the water is removed from the the Amashaya are taken to the Pakwashaya and they are Pond then aquatic plants and animals will not survive removed through Gudamarga. and died, like that Virechana will removes all pittaja diseases by eliminating pitta from the body. · It is the process of elimination of Mala either in Pakwa or in Apakwa Avastha but along with excess fluid Virechana Karma portions. The whole procedure has following steps: · It is less stressful procedure I. Purvakarma: It includes following, · . It is considered the best treatment for morbid 1. Collection of the drugs to manage the and increased Pitta Doshas. Virechana is even a treatment complications, & to handle the emergency. for Pitta Samsargaja Doshas, Kapha Samsrista Doshas and also for Pitta Sthanagata Kapha. 2. Detail examination of the person, indications, contra-indications etc. · It is worth mentioning that Virecana, unlike the modern purgatives, is not merely an act to open the 3. Snehana and Swedana: abhyantara snehapana, bowel, but is a complete therapeutic measure which has bahya snehana and swedana systemic as well as local effects. 5. Kala: early morning when previously taken food Indications: is digested, abhyanga & Swedana should be carried out during the gap of these 3 days. Virechana yogya rogi: Pinasa, kustha (soriasis), fever. Rajayakshma, cough, asthma, galagraha, 6. Diet & regimen: During Snehapana, drava, ushna, galaganda, slipada, diabetes, mandagni (improper anabhishyandi ahara should be consumed. Ushonodaka or delayed digestion), due to incompatible diet is mandatory, one should follow brahmacharya & avoid indigestion, visuchika, alasaka, adhomarga raktapitta, vyayama, krodha, shoka, hima & atapa, pravata, yana, snakebites,mental disorders, diarrhea, swelling, pandu, adhwa bhashya, atyasana sthiti, dhuma & raja also [4] mukhapaka etc. specially pitta pradhana vyadhi . should be avoided

Contra-indications: 7. Diet before Virechana: Diet containing jangala mamsa rasa, yusha & diet with snigdha, laghu, ushna Virechana ayogya rogi: delicated(weakness), any quality & kapha avriddhikara aharas are necessary injury at anal region, muktanala, adhogami raktapitta since manda kapha state is required during Virechana. (bleeding through anal region), after fasting, weak sense If during snehapana itself, dosha paka occurs in durbala organs, improper and delayed digestion, immediately & bahudosha patients & swayam pravritti of doshas after giving niruha basti, kama vasna chitta, indigestion, starts then one should give bhedaneeya bhojana[7,8] navajwara, madatya rogi, alcoholic, distention of abdomen, injury due to any foreign body or shalya, those 8. Matra vinischaya:. The matra, should be decided who is having any trauma or injury by accident, those according to agni & kostha of the person who had given snehana in more amount, atiruksha, krura kostha, kshata, garbhini etc. are said to be Avirechya[5]. Indian Journal of Forensic Medicine & Toxicology, April-June 2021, Vol. 15, No. 2 3483

II. Pradhana Karma: It starts from intake of · In tourist, Practicing virechan therapy in Sharad medicines, up to completion of Vegas. Rutu to healthy person for maintainance of health and to diseased person to cure disease will help to expand the 1. Virechana yoga sevana: Initially snehana & ayurveda globally. swedana should be completed successfully, followed by 3 days of gap wherein bahya Snehana & Swedana must Ethical Clearance- Taken from Institutional Ethical be completed. On the previous day of the karma, laghu, committee ushna & kapha avriddhikara drugs should be taken Conflict of Interest: NIL 2. Assessment of Virechana: Kaphanta Virechana Self is desired. Source of Funding-

Chakrapani has categorized Shuddhi under References 1. Tripathi R, Charak Saṃhita, 5th ed. Varanasi, 1. Antiki (end product) Chaukhambha Sansthan, 2017 Sutrasthana, 2. Vegiki (no. of vegas) 16 /21, p.252. 2. Garde GK, Ashtang hrudaya of Vaghbhata, 4th ed. 3. Maniki (quantity of vomited material) Varanasi, Chaukhamba Sanskrit Sansthan, 2018 Sutrasthan, 14/33, p.62. 4. Laingiki (Observations on the person[9] 3. Tripathi B, Charak Saṃhita, 5th ed. Varanasi, III. Paschat Karma: Rules and regulations Chaukhambha Sanskrit Sansthan, 2017 regarding diet and the regimen i.e. Sansarjana Krama Kalpasthana, 1/4, p.1072. which is decided depending upon the type of shuddhi[10] 4. Tripathi B, Charak Saṃhita, 5th ed. Varanasi, Chaukhambha Sanskrit Sansthan, 2017 Observations and Results Siddhisthana, 2/13, p.1181. · Health tourism is a golden way to explore 5. Tripathi B, Charak Saṃhita ,5th ed. Varanasi, Ayurveda, and also contributes towards economic Chaukhambha Sanskrit Sansthan, 2017 growth of the country Siddhisthana, 2/10, p.1179. 6. Shastri KA, Sushruta Samhita, 6th ed. Varanasi, · PanchaKarma therapy is considered as a Chaukhamba Sanskrit Sansthan , 2015 Chikitsasthan complete holistic approach to the elimination of the root , 33/27, p.180. cause of each and every chronic disease. 7. Tripathi B, Charak Saṃhita ,5th ed. Varanasi, · Virechana Karma is safe and effective treatment Chaukhambha Sanskrit Sansthan, 2017 modality for pitta disorders especially in sharad ritu and Siddhisthana, 1/8, p.1157. th can be effectively used even for the delicate person. 8. Shastri KA, Sushruta Samhita, 6 ed. Varanasi, Chaukhamba Sanskrit Sansthan, 2015 · Thus, Sharadiya virechana should be practiced Chikitsasthan, 33 /20, p.113 every year 9. Tripathi B, Charak Saṃhita ,5th ed. Varanasi, Chaukhambha Sanskrit Sansthan, 2017 Conclusion Siddhisthana, 1/13-14, p.1159. · Health tourism destinations provide high quality 10. Tripathi B, Charak Saṃhita ,5th ed. Varanasi, treatment at low cost in India. Chaukhambha Sanskrit Sansthan, 2017 Siddhisthana, 1/11, p.1158. · By being in own country an Ayurveda physician can contribute towards globalisation of Ayurveda through Health tourism.